Tiroid İnce İğne Aspirasyon Sitolojisinin Dijital Sitopatoloji ve Konvansiyonel Işık Mikroskobu ile Değerlendirilmesinin Karşılaştırmalı Analizi: Belirsiz Kategorilere Odaklanarak

Abstract

Amaç: Dijital patoloji, Tüm Slayt Görüntüleme (Whole Slide Imaging - WSI) teknolojisinin gelişmesiyle hızla ilerlemiştir; ancak sitopatolojide tanısal amaçlı kullanımı, teknik zorluklar nedeniyle sınırlı kalmaktadır. Bu çalışmada, tiroid ince iğne aspirasyon (İİA) sitolojisinde dijital sitopatoloji ile ışık mikroskobu (LM) arasında tanısal uyumun, özellikle belirsiz kategorilere odaklanılarak değerlendirilmesi amaçlanmıştır.

Gereç ve Yöntemler: Hacettepe Üniversitesi Tıp Fakültesi Patoloji Anabilim Dalı’nda 2023 yılında sitopatolog 1 (CP1) tarafından raporlanmış 60 tiroid İİA vakası (non-diagnostik olanlar hariç) arşivden çıkarıldı. Bağımsız bir sitopatolog (CP2) tarafından olgular tekrar değerlendirildikten sonra, preparat kalitesi düşük olan 6 vaka dışlandı. Elli dört vakaya ait 2 ila 3 adet temsili nitelikte preparat seçildi. Seçilen slaytlar Philips IntelliSite® cihazında tek düzlemde, x20 büyütmede tarandı. CP1, seçilen preparatları WSI üzerinden yeniden değerlendirdi ve LM ile WSI tanıları arasındaki uyum Cohen’s kappa istatistiği ile analiz edildi.

Bulgular: Elli dört vakanın LM ile konulan ilk tanıları şöyleydi: 15 benign, 18 önemi belirsiz atipi (AUS), 3 folliküler neoplazi, 8 malignite şüphesi (SM) ve 10 malign. WSI ile tekrar değerlendirildikten sonra 17 vakada (%31,4) tanı değişikliği gözlendi. En fazla uyumsuzluk AUS ve SM kategorilerinde görüldü. Genel tanısal uyum orta düzeyde olup kappa değeri 0,584 olarak bulundu. Uyumsuz 17 vakanın 10'u gözlemci içi yorum farklılığına, 7'si ise dijital görüntüleme ile ilgili sınırlamalara (örneğin kalın hücre grupları, örtücü materyal, dijital slayt kullanımına aşina olmama) bağlı olarak değerlendirildi.

Sonuç: Tiroid sitopatolojisinde WSI ve LM ile konulan tanılar kabul edilebilir düzeyde bir uyum göstermektedir. WSI teknolojisinin gelişmesi ve patologların dijital araçlara daha fazla aşinalık kazanması, bu yöntemin daha yaygın olarak kullanılmasını destekleyecektir.

Keywords

• Tüm Slayt Görüntüleme
• Dijital
• Sitopatoloji
• Tiroid

Project Number

SBA 25/540

Ethical Statement

Hacettepe Üniversitesi Sağlık Bilimleri Araştırma Etik Kurulu tarafından SBA 25/540 kayıt numaralı “Tiroid İnce İğne Aspirasyon Sitolojisinde Dijital Sitopatoloji ile Konvansiyonel Işık Mikroskobu Değerlendirmesinin Karşılaştırmalı Analizi: Belirsiz Kategorilere Odaklanarak” başlıklı araştırma önerisi gerekçe, amaç, yaklaşım ve yöntemleri dikkate alınarak incelenmiş olup etik açıdan uygun bulunmuştur.

A COMPARATIVE ANALYSIS OF DIGITAL CYTOPATHOLOGY AND CONVENTIONAL LIGHT MICROSCOPY EVALUATION OF THYROID FINE NEEDLE ASPIRATION CYTOLOGY: FOCUSING ON INDETERMINATE CATEGORIES

Abstract

Objective: Digital pathology has rapidly evolved with the advent of Whole Slide Imaging (WSI); however, its diagnostic use in cytopathology remains limited due to technical challenges. This study aimed to evaluate the diagnostic concordance between digital cytopathology and conventional light microscopy (LM) in thyroid fine needle aspiration (FNA) cytology, focusing on indeterminate categories according to the Bethesda System for Reporting Thyroid Cytopathology.

Material and Methods: Sixty thyroid FNA cases, excluding non-diagnostic ones, signed out by cytopathologist 1 (CP1) in 2023 at Hacettepe University Faculty of Medicine Department of Pathology were retrieved from the archives. After the cases were reviewed by an independent cytopathologist 2 (CP2), six cases were excluded due to poor slide quality. For the remaining 54 cases, the most representative 2 to 3 slides were selected and scanned using Philips IntelliSite Pathology Solution Systems®  in 1 focal Z-plane, at x20 magnification. CP1 re-evaluated the selected slides via WSI, and diagnostic agreement between digital cytopathology and LM was assessed by Cohen's kappa statistics.

Results: Of the 54 cases, the initial LM diagnoses were: 15 benign, 18 atypia of undetermined significance (AUS), 3 follicular neoplasia, 8 suspicious for malignancy (SM), and 10 malignant. After WSI review, 17 cases (31.4%) showed diagnostic changes, mostly in the AUS and SM categories. The overall diagnostic concordance showed a moderate level of agreement (kappa=0.584). Among the discrepant cases, 10 were attributed to intraobserver variability, while 7 were due to digital imaging limitations, such as thick cell clusters, obscuring material, and unfamiliar virtual slide navigation.

Conclusion: Digital cytopathology demonstrates acceptable concordance with LM. In digital cytopathology, the main challenges are the greater scanning area of the glass slides, obscuring material, and variable smear thickness with 3-dimensional cell groups. Continued improvements in WSI technology and pathologist familiarity with digital tools are essential for broader adoption.

Keywords

• Whole Slide Imaging
• Digital
• Cytopathology
• Thyroid

Project Number

SBA 25/540

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